The opioid epidemic has had devastating impacts in recent years, affecting the lives of those battling addiction as well as their family, friends, and colleagues. Children, too, are deeply affected; they may be separated from parents with substance abuse disorders if their caretaker becomes incarcerated, needs to enter a rehabilitation program, or becomes unable to care for them. First-hand accounts and interviews collected by non-profit groups and the media suggest that nearby family members typically step in first to take care of these children, followed by the foster care system.

Data from the American Community Survey and the Centers for Disease Control, as well as recent research from the Census Bureau supports these findings: the share of grandparents raising grandchildren was often higher in states with higher opioid prescribing rates.[1] (It is important to note that opioid prescriptions are not the only reason why grandparents are raising grandchildren, but are typically associated with higher rates of opioid prescriptions.)

Alabama, Arkansas, Louisiana, and Mississippi—all located in the Southeast—had some of the highest rates of both grandparents raising their grandchildren as well as people being prescribed opioids in 2016. More broadly, opioid prescribing rates are quite high across all southeastern states. Only the state of Virginia (63.4) had a rate lower than the national average of 66.5 prescriptions per 100 people.

Do these trends hold for North Carolina’s counties?

Carolina Demography sought to understand how these trends look at the county-level within North Carolina. Recent data has been released for 2017, resulting in slightly different results than those in the Census Bureau report linked above.

Nationally, the states that have the highest percentage of grandparents raising grandchildren are Mississippi (2.7%), Arkansas (2.2%), Louisiana (2.1%), Alabama (2.1%), compared to the nationwide average of 1.3%. In North Carolina, the statewide average of grandparents caring for their grandchildren is 1.6%.

In North Carolina, several counties exceed the national average of grandparents acting as primary caregivers for their grandchildren as well as the statewide rates listed above. Several of these also had high opioid prescription rates.

The Sandhills region—which is comprised of Bladen, Columbus, Cumberland, Hoke, Montgomery, Moore, Richmond, Robeson, Sampson, and Scotland Counties—had both the highest rates of grandparents as primary caregivers as well as the highest opioid prescription rates. Two Sandhills counties—Scotland and Columbus—exceeded the state and national averages on both measures.

Grandparent caregiver rates in North Carolina counties

The top ten North Carolina counties with the highest rates of grandparents acting as primary caregivers were:

  1. Anson County (5.4%)
  2. Clay County (4.6%)
  3. Graham County (3.9%)
  4. Scotland County (3.7%)
  5. Robeson County (3.6%)
  6. Columbus County (3.4%)
  7. Sampson County (2.9%)
  8. Person County (2.9%)
  9. Martin County (2.9%)
  10. Bladen County (2.8%)

Five of these ten counties are located in the Sandhills region, and all exceeded the state average of 1.6%. The share of grandparents raising their own grandchildren in these counties exceeded rates in the top five states: Mississippi (2.7%), Arkansas (2.2%), Louisiana (2.1%), Alabama (2.1%) and Kentucky (2.1%).

For the majority of these grandparents, caretaking has been a long-term job. In all counties except Person, at least 50% of grandparents have taken care of their grandchildren for three years or more.

Opioid prescribing rates in North Carolina counties[2]

North Carolina counties with the highest rates of prescriptions per 100 people were:

  1. Scotland County (168)
  2. Columbus County (140)
  3. Surry County (139)
  4. Richmond County (138)
  5. Beaufort County (131)
  6. Burke County (125)
  7. Mitchell County (124)
  8. Hertford County (123)
  9. Rockingham County (121)
  10. Caldwell County (119)

In each of these counties, the prescription rate exceeded 100, meaning that there were enough prescriptions dispensed that each person in the county could have one. This is compared to the state rate of 72 prescriptions per 100 people, which is higher than the national rate of 58.7.

Number one and two on this list—Scotland and Columbus counties in the Sandhills region—were also among those with the highest rates of grandparents acting as primary caregivers, at 3.7% (4th-highest) and 3.4% (6th-highest) respectively.

Counties with higher-than-average prescription rates also tended to have grandparent-caregiver rates exceeding the state average, except for Surry, Mitchell, and Hertford counties.

In counties with the lowest prescribing rates, rates were below the national average of 58.7 prescriptions per 100 people:

  1. Gates County (1)
  2. Caswell County (8)
  3. Northampton County (15)
  4. Currituck County (15)
  5. Alexander County (20)
  6. Bertie County (25)
  7. Greene County (29)
  8. Warren County (30)
  9. Perquimans County (30)
  10. Jones County (37)

Half of these counties had grandparent-caregiver rates above the state average (1.6%), while half fell below the state average.

In summary, counties with prescribing rates exceeding the state average also tended to have higher-than-average grandparent caregiver rates. This pattern was most apparent in the Sandhills region. We should note that grandparents care for their grandchildren for a variety of reasons—so the opioid crisis doesn’t completely explain this pattern—but there does appear to be a link between counties with higher rates of opioid perscriptions and grandparents taking on the role of primary caregivers for their grandchildren.

Families and communities in North Carolina are increasingly stretched thin as a result of this epidemic. When family members cannot take care of a neglected child, foster care and social services must step in, and many agencies in the state are seeing a spike in demand as a result of opioid abuse in homes.

Projects like ncIMPACT’s Opioid Response Project are working to meet these challenges in our state. They’re engaged in collaborative partnerships with various state and local agencies to help ten NC communities tackle their opioid crises.

[1] Prescribing rates measure the total number of opioid prescriptions dispensed in a given year and area divided by the total population, represented as a rate per 100 residents.

“For this database, a prescription is an initial or refill prescription dispensed at a retail pharmacy…and paid for by commercial insurance, Medicaid, Medicare, or cash or its equivalent. This database does not include mail order pharmacy data.” (CDC, 2017)

[2] Note: Opioid prescribing data was available for all counties except Camden County.


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